The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study

Abstract Background To date, there is no consensus on the utility of screening procedures for the early detection of endometrial cancer. The value of transvaginal ultrasound for screening of asymptomatic endometrial cancer has been discussed controversially. This study was conducted to evaluate whether asymptomatic patients with endometrial cancer have a better prognosis than symptomatic patients with endometrial cancer diagnosed after postmenopausal bleeding. Methods In the present multi-center study, the effect of the presence of postmenopausal bleeding on prognosis was evaluated retrospectively in 605 patients with endometrial cancer using patients' files. 543 patients (133 patients were asymptomatic, 410 patients were symptomatic) with endometrioid endometrial cancer were enrolled in all further analysis. Student's t-test, Cox regression analysis and Kaplan-Meier analysis were used were appropriate. Results Presence/absence of a postmenopausal bleeding was not associated with tumor stage (p = 0.2) and age at diagnosis (p = 0.5). Asymptomatic patients with endometrial cancer had a significantly higher rate of well and moderate-differentiated tumors compared to symptomatic patients (p = 0.008). In univariable and multivariable survival analysis, tumor stage, tumor grade, and patients' age at diagnosis, but not presence/absence of a postmenopausal bleeding, were associated with disease free and overall survival. Conclusion Asymptomatic patients with endometrial cancer have a higher rate of well differentiated tumors compared to patients with a postmenopausal bleeding prior to diagnosis. The prognosis of both groups of patients was similar.</p

Anticipation boosts forgetting of voluntarily suppressed memories

The role of anticipatory mechanisms in human memory control is poorly understood. Addressing the issue, we investigated whether the presence of an anticipatory phase can enhance effects of cognitive control, as they occur during voluntary suppression of episodic memories. Using the Think/No-Think task, participants first learned several face-word associations, and thereafter were asked to either recall (think) or suppress (no-think) the word when provided with the word's face cue. In the one condition, participants performed the Think/No-Think task in the presence of an anticipatory phase, giving participants the chance to prepare for memory suppression. In the other condition, participants performed the task without such an anticipatory phase. On the final cued recall test, participants were asked to recall all of the previously studied words. The results showed stronger forgetting of to-be-suppressed items in the presence than absence of the anticipatory phase. The finding is first evidence for the effectiveness of anticipatory mechanisms in human memory suppression

Anticipatory signatures of voluntary memory suppression

Voluntary memory suppression can keep unwanted memories from entering consciousness, inducing later forgetting of the information. In the present study, we searched for the existence of anticipatory processes, mediating such voluntary memory suppression. Using the think/no-think paradigm, subjects received a cue whether to prepare to think of a previously studied cue-target pair or whether to not let a previously studied cue-target pair enter consciousness. Examining event-related potentials, we identified two electrophysiological processes of voluntary memory suppression: (i) an early anticipatory process operating before the memory cue for a to-be-suppressed memory was provided, and (ii) a later process operating after memory cue presentation. Both ERP effects were due to a decreased right frontal and left parietal positivity. They were positively related and predicted later forgetting. The results point to the existence of anticipatory processes, mediating voluntary memory suppression

Notching and Pulsatility Index of the Uterine Arteries and Preeclampsia in Twin Pregnancies

Increased uterine artery Doppler indices have been shown to be associated with preeclampsia and adverse pregnancy outcomes in singleton and twin pregnancies. At 20&ndash;22 weeks of gestation, we assessed the use of notching, the highest, lowest, and mean pulsatility index (PI), and the combination of notching and PI of the uterine arteries to screen for preeclampsia. This was done in a cohort of 380 twin pregnancies. The results showed that the combination of notching and the highest PI above the 95th centile of the uterine arteries gives the best screening characteristics for preeclampsia in twin pregnancies. We calculated sensitivities for preeclampsia for notching, highest PI, and the combination of notching and the highest PI of 50%, 45% and 91%, with specificities of 96%, 96% and 93%, respectively. The present findings demonstrate that notching, increased highest PI, and the combination of notching and the highest PI of the uterine arteries is associated with an increased risk of preeclampsia in twin pregnancies. We observed the highest sensitivity and specificity by using the combination of notching and the highest PI of the uterine arteries

Common oxytocin receptor gene polymorphisms and the risk for preterm birth. Disease markers

Abstract. Oxytocin is crucially involved in the onset and maintenance of labor. We investigated the association between oxytocin receptor gene polymorphisms and preterm birth. The presence of four common oxytocin receptor gene polymorphisms (rs2254298, rs53576, rs2228485 and rs237911) was evaluated in one hundred women with preterm birth and one hundred healthy women using restriction fragment length polymorphism genotyping. No association was found between the presence of any individual oxytocin receptor gene polymorphism and preterm birth. In haplotype analysis, the haplotype combination of rs2254298 A allele, rs2228485 C allele and rs237911 G allele was found to be significantly associated with an increased risk of preterm birth (OR = 3.2 [CI 1.04-9.8], p = 0.043). In conclusion our findings suggest that a combination of three oxytocin receptor gene polymorphisms is associated with an increased risk for preterm birth. We propose further studies investigating the role of oxytocin receptor gene polymorphisms and preterm birth

Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial

<div><p>Introduction</p><p>To investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome.</p><p>Material and Methods</p><p>Women undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1∶1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle.</p><p>Results</p><p>A total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p = 0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p = 0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.</p><p>Conclusions</p><p>Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01542346" target="_blank">NCT01542346</a>.</p></div

Results 6 month following cesarean delivery (n = 91).

<p>Values are given as median (range) or numbers (%), ^†Mann Whitney U test or chi square test. <i>RR,</i> Relative Risk (95% Confidence Intervall); <i>δ</i>, Cliffs Delta; <i>OSAS</i>, Observer Scar Assessment Scale; <i>POSAS</i>, Patient and Observer Scar Assessment Scale; <i>PSAS</i>, Patient Scar Assessment Scale; <i>VSS</i>, Vancouver Scar Scale.</p><p>Results 6 month following cesarean delivery (n = 91).</p

Results at discharge and 2 months following cesarean delivery (n = 91).

<p>Values are given as median (range) or numbers (%), ^†Mann Whitney U test, Fisheŕs exact test or chi square test. <i>RR,</i> Relative Risk (95% Confidence Intervall); <i>δ</i>, Cliffs Delta; <i>n/a</i>, not applicable; <i>OSAS</i>, Observer Scar Assessment Scale; <i>POSAS</i>, Patient and Observer Scar Assessment Scale; <i>PSAS</i>, Patient Scar Assessment Scale; <i>VSS</i>, Vancouver Scar Scale.</p><p>Results at discharge and 2 months following cesarean delivery (n = 91).</p